Let's ramble!

hospital

Hospitals have always had ups and downs, according to the New York Times (2018). During the 19th century, wealthier people preferred being treated by doctors in their homes and hospitals were seen as a place for poorer people. Hospitals were not known for having good conditions. However, research led hospitals to learn some of the best practices and new technologies, such as anesthesia, which allowed hospitals to give better treatment than at home.

These new pratices and technologies caused more people to start going to hospitals. But now, people are once again shifting towards medical assistance at home or choosing to go to small clinics rather than going to hospitals. Why are these changes happening and what has been the implications for healthcare facilities?

Source: Wikimedia Commons

Why are hospitals shutting down?

According to the New York Times (2018), the maximum number of hospitalizations in the US was over 39 million, in 1981. Even though the population has increased, hospitalizations have decreased by 10 percent! (New York Times, 2018). There are many different reasons explaining these numbers.

Aside from less patient admissions, the number of days a patient spends in a hospital is much shorter than before. Previously, a patient who had surgery could spend a week or longer in the hospital. However, now patients who have surgery sometimes stay only one day! This is one of the reasons for the reduction of hospital beds. According to Modern Healthcare (2015), new technologies and better medications can either reduce the length of the stay of a patient, or receive the necessary treatment outside of a hospital.

Second, one of the biggest problems that hospitals face today are hospital-acquired infections and trying to control the spread of infection. Hospital-acquired infections are becoming an increasingly serious problem, especially with the rise of drug-resistant suberbugs.

According to the Center for Disease Control and Prevention, in 2002, there were 1.7 million cases of HAIs, and that number has only been increasing. Controlling the spread of bacteria in hospitals has become increasingly challenging and, as you have seen on this blog, researchers are constantly finding new sources of infection. As people are becoming more aware of this risk, they are opting for either smaller healthcare facilities with less risk or at-home care.

One of the biggest causes for hospital closures is lack of funding; some hospitals simply cannot sustain themselves. In the US especially, this is in part due to patients being unable to pay hospital fees or having complications with insurance companies and, therefore, postponing their treatments. Hospitals are now scrambling to cut costs, however, this does not always work and has led to many closures.

The costs of shutting down hospitals

The majority of hospitals being shut down are in rural and small town areas, where people are far from cities. These closures can lead to many problems for these people. Doctors may lose their jobs or have to relocate to other cities to practice. Similarly, patients no longer have the option of having a regular, family doctor and need to relocate themselves in order to seek medical attention. They will also incur higher costs to reach the hospital, since they have to travel to hospitals. They lose time travelling, which may even be deadly in some cases. Finally, in the video example below, we see that the loss of jobs from a hospital closure can be detrimental to a small town’s economy, leading to the closure of other companies.

What does the future for hospitals look like?

So what is going to happen to hospitals? Will they eventually all disappear? Although a total disappearance is highly unlikely, it seems that hospital closures are becoming unavoidable, due to the risks associated with hospital-acquired infections, changing consumer preferences and lack of funds to maintain hospitals. There has already been a signifcant number that have been closed since 1981; in 1981, the US had 6933 hospitals and by 2017 this number had dropped to 5534 (New York Times, 2018). And this trend is expected to continue in Western countries. We’ll just have to wait and see what the outcome will be…

Hospital-acquired infections are a serious threat in healthcare facilities today and researchers keep finding new sources of these infections. We know that sources of HAIs include surfaces, high-touch objects, hands and medical devices, but did you know that these infections can also occur due to the water and plumbing systems in healthcare facilities?

Source: Public Domain Pictures

According to Infection Control Today (2018), “Potable and utility water systems in healthcare settings are reservoirs and vectors of Hospital-acquired infections, resulting in pneumonias, bacteremias, skin infections, surgical site infections, eye infections and others.”

Hospitals are major users of potable water, whether it be for drinking, bathing, hand-washing or rinsing medical devices. It is therefore important that healthcare facilities realize that the water entering their facilities is not considered sterile.

Why is the water in plumbing systems infected? The design of and water use patterns in premise plumbing creates biofilms, which provide shelter and food for harmful bacterias. According to Infection Control Today (2018), “Biofilms in premise plumbing systems are complex ecosystems, and it is within these biofilms that bacteria, fungi and amoeba find the food, water and shelter they need.” Many bacteria develop in the biofilms, such as Legionella, Ancinetobacter aumanniii, Aspergillus flavus, etc.

Legionella – what is it and how does it affect patients in a healthcare setting?

Legionella colonies

Source: Wikimedia Commons

Legionella is one example of a bacteria that is found naturally in water. This bacteria is known for causing Legionnaires’ disease: a severe form of pneumonia. This disease is one of the most significant waterborne infections. Legionnaires normally has a mortality rate of only 10%, however, if acquired in a hospital, this rate goes up to anywhere between 25-50% (Infection Control Today, 2018)! Hospitals experience the highest number of outbreaks of Legionnaires disease (compared to other types of buildings) due to having a large number of patients with weakened immune systems or that have chronic diseases. It is important to note that the majority of Legionnaires cases in hospitals are due to the drinking water system.

How to reduce the risk of wHAIs: education and water management programs

So now that we are aware of waterborne hospital acquired infections (wHAIs), is there a way to reduce the risk that potable water poses to healthcare facilities? Infection Control Today (2018) suggests both education and water management programs as possible solutions to reducing the wHAI risk. Firstly, through education, it is important that healthcare workers know that potable water does carry bacteria and does cause an increase in HAIs. Second, once this idea of water carrying bacteria is understood, it will be important to implement water management programs. There can be no standardized water management programs, as all facilities differ in factors such as age of establishment and system, overall design of plumbing system, populations served, etc. Some hospitals have already tried different methods of water disinfection. Examples of these methods used to reduce risk include the use of sterile water in high-risk patient areas, engineering controls and point-of-use water filters.

To summarize, healthcare facilities must realize the risk that water and plumbing systems pose to their patients and employees. Hospital-acquired infections are one of the leading causes of death in North America and it is therefore crucial that hospitals take action against any source that could spread these infections. Education and water management programs are the best ways to help reduce the risk of wHAIs, according to Infection Control Today (2018).

The days when visual room inspection used to be the gold standard for monitoring hospital cleanliness is long gone. Even though this practice is still useful, better and more objective ways have seen the light. One of the most scientific way is surface cultivation. However, surface cultivation is labor intensive and lacks on the spot results. Invisible UV markers and UV light are also a good way to validate if a place was cleaned. However, its application is limited and the data are not telling more then if a surface was cleaned or not at a given time. ATP testing is becoming more and more useful to verify cleanliness beyond visual inspection.

How does ATP monitoring works?

ATP monitoring is a simple and quick way for hospital to measure residual organic matter on a surface, device or piece of equipment. Adenosine triphosphate or ATP is an organic molecule found in every living or once-living organism. Essentially, the person conducting ATP monitoring swabs the surface of concern, and insert that swab into a handheld unit called a luminometer. Results are available within seconds. Good products will come with a free software that will permit to identify problematic areas, monitor trends and store results. It is a very tool to add to an audit system.

Fast, reliable and quality results

It is important to understand that ATP testing is not a microorganism detection method. ATP testing, is a cleaning verification test. It won’t tell you what’s on the surface, but it will tell you that there is something on the surface. A lot of healthcare professionals see the value that ATP monitoring offers. It empowers auditors, infection prevention staff and environmental services specialist to verify if cleaning was done properly in seconds. The speed at which the results are obtained is very appreciated in healthcare settings. If a result is out of specification, then corrective action can be taken immediately. Infection control staff often witness a direct correlation between low ATP levels and lower healthcare associated infection rates. Remember that environmental contamination is directly linked to up to 40% of healthcare associated infections.